丙泊酚联合艾司氯胺酮抑制全麻插管反应时丙泊酚的ED50和ED95

ED 50 and ED 95 of propofol in the combination use of propofol and esketamine in inhibiting the response to intubation under general anesthesia

目的探讨丙泊酚复合艾司氯胺酮进行全麻诱导时,可抑制插管反应的丙泊酚的有效剂量。方法选择贵州医科大学附属肿瘤医院2023年3-4月自愿接受全身麻醉下行择期手术的患者26例,男13例,女13例,年龄18~65岁,BMI 18~28 kg/m^(2),ASA I~II级。所有患者静脉注射舒芬太尼0.3μg/kg、艾司氯胺酮0.5 mg/kg,丙泊酚初始剂量设置为1.5 mg/kg,相邻患者丙泊酚剂量差值为0.1 mg/kg,待患者睫毛反射和意识消失(MOAA/S评分≤1)且BIS≤60时,静脉推注罗库溴铵0.6 mg/kg,90 s后可视喉镜引导下行气管插管。若插管反应为阳性,下一例患者升高一个梯度;阴性则降低一个梯度,出现第7个转折点时终止试验。采用Probit概率法计算丙泊酚的ED50、ED95及相应95%可信区间(Confidence interval,CI)。结果丙泊酚的ED50为1.377 mg/kg(95%CI:1.293~1.444 mg/kg),ED95为1.526 mg/kg(95%CI:1.454~1.931 mg/kg)。结论丙泊酚联合艾司氯胺酮(0.5 mg/kg)抑制插管反应的ED50和ED95分别为1.377 mg/kg和1.526 mg/kg,减少了诱导过程中丙泊酚的用量,更有利于血流动力学的稳定。

Objective To investigate the effective dose of propofol in the combination use of propofol and esketamine to inhibit intubation response.Methods A total of 26 patients(13 males and 13 females),from the Affiliated Cancer Hospital of Guizhou Medical University,aged 18~65 years old,BMI 18~28 kg/m ^(2),ASA physical status I~II,who voluntarily underwent elective surgery under general anesthesia from March to April 2023,were selected.All patients received intravenous sufentanil 0.3μg/kg and esketamine 0.5 mg/kg;the dose of propofol in the first patient was 1.5 mg/kg,and the dose difference of propofol in the adjacent patients was 0.1 mg/kg.When the subject′s eyelash reflex and consciousness disappeared(MOAA/S score≤1)and BIS≤60,rocuronium 0.6 mg/kg was injected intravenously.After 90 s,tracheal intubation was performed under the guidance of video laryngoscope.If the intubation response was positive,the dose for the next patient was raised by a gradient;if results were negative,the dose was reduced by one gradient,and the study was terminated when seven crossover inflection points appeared.Propofol′s ED 50,ED 95 and corresponding 95%confidence interval(CI)were calculated by Probit probability method.Results The ED 50 of propofol was 1.377 mg/kg(95%CI:1.293~1.444 mg/kg),and the ED 95 was 1.526 mg/kg(95%CI:1.454~1.931 mg/kg).Conclusion The ED 50 and ED 95 of propofol in the combination use of propofol and esketamine 0.5 mg/kg to inhibit intubation response are 1.377 mg/kg and 1.526 mg/kg,respectively,and the dosage of propofol is reduced during induction,which is more conducive to hemodynamic stability.